Medical labour under neoliberalism: an ethnographic study in Colombia.

OBJECTIVES: In order to increase the knowledge about the impacts of neoliberal market forces on physician's labour, this article's objectives are to analyse how and why the labour of physicians is transformed by neoliberalism, and the implications of these transformations for patient care. METHODS: Ethnographic investigation is carried out through semi-structured interviews with 20 general practitioners at public and private facilities in Colombia. The interviews were contrasted with national studies of physician's labour since the 1960s. A "mock" job search was also simulated. The analysis was guided by Marxian frameworks. The study was approved by a Human Research Ethics Committee, and informed consent was obtained from all participants. RESULTS: The overpowering for-profit administration of the Colombian healthcare system imposes productivity mechanisms on physicians as a result of a deregulated labour market characterized by low salaries, reduced and self-funded social security benefits, and job insecurity. Overworked physicians with reduced autonomy become frustrated for not being able to provide the care their patients need according to clinical standards. CONCLUSIONS: Under neoliberal conditions, medical labour becomes exploitable and directly productive through its formal and real subsumption to Capital. The negative consequences of a progressive loss in physician's autonomy unveil the incompatibility between neoliberal health systems and people's health.

Ethnographic research in immigrant-specific drug abuse recovery houses.

Access to study populations is a major concern for drug use and treatment researchers. Spaces related to drug use and treatment have varying levels of researcher accessibility based on several issues, including legality, public versus private settings, and insider/outsider status. Ethnographic research methods are indispensable for gaining and maintaining access to hidden or "hard-to-reach" populations. Here, we discuss our long-term ethnographic research on drug abuse recovery houses created by and for Latino migrants and immigrants in Northern California. We take our field work experiences as a case study to examine the problem of researcher access and how ethnographic strategies can be successfully applied to address it, focusing especially on issues of entrée, building rapport, and navigating field-specific challenges related to legality, public/private settings, and insider/outsider status. We conclude that continued funding support for ethnography is essential for promoting health disparities research focused on diverse populations in recovery from substance use disorders.

Lonely drinking fountains and comforting coolers: paradoxes of water value and ironies of water use.

This article focuses ethnographically on Americans and technologies of drinking water, as tokens of and vehicles for health, agency, and surprising kinds of community. Journalists and water scholars have argued that bottled water is a material concomitant of privatization and alienation in U.S. society. But, engaging Latour, this research shows that water technologies and the groups they assemble, are plural. Attention to everyday entwining of workplace lives with drinking fountains, single-serve bottles, and spring water coolers shows us several different quests, some individualized, some alienated, but some seeking health via public, collective care, acknowledgment of stakeholding, and community organizing. Focused on water practices on a college campus, in the roaring 1990s and increasingly sober 2000s in the context of earlier U.S. water histories of inclusion and exclusion, I draw on ethnographic research from the two years that led up to the recession and the presidential election of 2008. I argue for understanding of water value through attention to water use, focusing both on the social construction of water and the use of water for social construction.

Constructing a sense of community in rapidly growing European cities in the eleventh to thirteenth centuries.

The rapid growth of cities from the eleventh to the thirteenth century raises the question of how a sense of community was created among inhabitants who were migrants from disparate backgrounds. Before urban institutions and legislation emerged, informal social structures based on trust networks appear to have fostered socialization and an adaptation to new ways of life. Travelling merchants created various kinds of associations which were at the origins of the sworn communes. The merchants' guilds also strove to protect citizens on their travels. The growth of the cities led to the need to institutionalize these functions.

Acercamiento antropológico de la alimentación y salud en México / Anthropological approach to nutrition and health in Mexico

En este artículo presento un panorama de la alimentación en México, particularmente sobre la ciudad de México desde una perspectiva antropológica considerando aspectos socioculturales y económicos. Inicia con una breve revisión de los estudios antropológicos sobre alimentación en México, para reconocer tanto los aportes metodológicos como los principales problemas de estudio. Posteriormente, se presentan algunos datos de contextualización del país y de la ciudad que enmarcan los datos nutricios y alimentarios característicos. En las siguientes secciones se proponen algunas explicaciones sobre algunos de los fenómenos alimentarios contemporáneos, donde la obesidad es la característica principal en una sociedad de reciente acceso al consumo masivo, al mismo tiempo que se enfrenta al ideal cultural de delgadez. Los datos sobre la alimentación en México y los fenómenos sociales relacionados dan cuenta de la complejidad del fenómeno alimentario y de cómo los procesos macrosociales afectan las decisiones cotidianas de la gente. El análisis antropológico de la alimentación en la población mexicana ha permitido mostrar la relación entre estos procesos históricamente y en fechas recientes. Son la muestra de la utilidad de la metodología antropológica para estudiar la alimentación contemporánea, llena de contradicciones, que tienen que ver con el desarrollo del capitalismo y la sociedad de consumo, la promoción al consumo, y el acceso inmediato a él, la medicalización de la vida cotidiana, las ideas sobre el control corporal, y la imagen como un elemento de estatus.

This paper presents an overview of food in Mexico, particularly in Mexico City, from an anthropological perspective considering sociocultural and economic aspects. It begins with a brief review of anthropological studies on food in Mexico to recognize both the methodological contributions as the major problems of study. Subsequently, are presented some facts of contextualization of the country and city that frame the distinctive food and nutritional data. The following sections propose some explanations of some of the phenomena of contemporary food, where obesity is the main feature in a society of recent consumer access, while facing the cultural ideal of thinness. The data on food in Mexico and related social phenomena account for the complex nature of food and how macro-processes affect people's everyday decisions. The anthropological analysis of food in the Mexican population has been allowed to show the relationship between these processes historically and recently. They are the sign of the usefulness of anthropological methodology to study contemporary food, full of contradictions that have to do with the development of capitalism and consumer society, consumer promotion, and immediate access to it, the medicalization everyday life, ideas about body control, and image as an element of status.

"Monkeys, babies, idiots" and "primitives": nature-nurture debates and philanthropic foundation support for American anthropology in the 1920s and 1930s.

There has been a long discussion among historians about the impact that foundation policies had on the development of the social sciences during the interwar era. This discussion has centered on the degree to which foundation officers, particularly from the Rockefeller boards, exercised a hegemonic influence on research. In this essay, I argue that the field of American cultural anthropology has been neglected and must be reconsidered as a window into foundation intervention in nature-nurture debates. Despite foundation efforts to craft an anthropology policy that privileged hereditarian explanations, I contend that cultural anthropologists were committed to proving the primacy of "nurture," even when that commitment cost them valuable research dollars. It was this commitment that provided an essential bulwark for the discipline. Ironically, it was the need to negotiate with foundations about the purpose of their research that helped cultural anthropologists to articulate their unique, and thus intrinsically valuable, approach to nature-nurture debates.

Household economic strategies and nutritional anthropometry of women in American Samoa and highland Bolivia.

This study compares findings from research projects involving different genetic, environmental, and cultural contexts: a study of lifestyle and health from American Samoa (ASLS) and the Bolivian project. Reproduction and Ecology in Provincia Aroma (REPA). This paper presents analyses of varying economic strategies and their association with nutritional status indicators in each population. The ASLS sample includes 66 Samoan women and the REPA sample includes 210 Aymara women. Principle components analysis of household economic resources within each sample extracted two significant factors: one represents modernizing influences including education and occupational status, and the other represents ethnographically salient traditional economic behavior. The traditional pattern includes adding household members in Samoa and selling agricultural products in Bolivia. This analysis places each woman along two continua, traditional and modern, based on her household mobilization of economic resources, permitting an understanding of the patterns underlying household economic behavior that is not possible in univariate analyses of socioeconomic variables. For the Bolivian women the strategy involving more education and higher occupational status was associated with higher measures of several nutritional status indicators, including body mass index, arm muscle area, and peripheral skinfolds. But among the Samoan women, where substantial obesity was the norm, there were no significant differences in anthropometric measurements based on economic strategies. These data argue for the importance of directly measuring the potential consequences of variation in household economic strategies rather than merely inferring such, and of assessing ethnographically relevant aspects of household economic production rather than limiting analyses to non-context-specific economic indicators such as income. This focus on household strategy is likely to be fruitful especially where economic and nutritional conditions are marginal. The findings from Bolivia also support efforts in developing countries to improve girls' education, and thereby occupational prospects, as a means to improve their health status as women.

Intrahousehold resource allocation and child growth in Mozambique: an ethnographic case-control study.

This study examines the effect of intrahousehold cash income control and decision-making patterns on child growth in the rural town of Sussundenga in Manica Province, Mozambique. A case-control study design was used to examine the influence of men's and women's disaggregated cash incomes on child growth. The research tested whether greater maternal share of household cash income was associated with (1) increased maternal decision-making and bargaining power in the household, and (2) better child growth. Fifty case households, with children 1-4 years old exhibiting poor growth, were matched with 50 control households of similar socioeconomic status in which all children under five demonstrated healthy growth. Data were gathered on gender-specific income generation and expenditure, specific intrahousehold allocation processes, diet, and sociodemographic variables using a formal survey. Key informant interviews, focus groups, and observation over one year provided ethnographic context for the case-control findings. Case-control differences were analyzed using McNemar's test, paired t-test, and conditional logistic regression. In spite of matching households for socioeconomic status, control household incomes were still slightly greater than cases. Male spouse income was also higher among controls while maternal income, and maternal proportion of household income, were not significantly different. Household meat, fish and poultry consumption, and maternal education were significantly greater among control households than cases. Greater maternal share of household income was not associated with greater maternal decision-making around cash. However, mothers must spend what little cash they earn on daily food supplies and usually request additional cash from spouses to cover these costs. There is evidence that if mothers earn enough to cover these socially prescribed costs, they can spend cash for other needs. Above this threshold, women's earnings may confer more bargaining power. The research also revealed a nuclearization of households, attenuation of community bonds of mutual aid, and increasing importance of cash for survival.